What are uterine fibroids?

Uterine fibroids are tumors that grow within and around the wall of the uterus. They are the most common non-cancerous (benign) tumor in women with an incidence of 40-70%. Fibroids come in all sizes. Most women with fibroids have more than one. The ones most likely to cause symptoms tend to be larger (grapefruit size) and close to the lining of the uterus (submucosal).

Fig. 1: Uterine Fibroids

What are the symptoms?

Many women with uterine fibroids have no symptoms. Approximately one third of women with fibroids will present with symptoms that include:

• Abnormal menstrual cycles with heavy bleeding
• Severe menstrual cramping with pelvic pain and pressure
• Frequent urination
• Back and leg pain
• Painful intercourse
• Infertility

Who are at risk for uterine fibroids?

The following women are at most risk for developing symptomatic fibroids:

• Women in their 40's who haven't had children (nulliparous)
• Those with a family history of fibroid related symptoms
• African American descent

How are uterine fibroids diagnosed?

Fibroids may be diagnosed in a variety of ways including a physical examination of the pelvis, pelvic ultrasound or pelvic MRI.

What are the treatments for uterine fibroids?

As part of the UCLA Fibroid Therapy Program, we offer a variety of treatments for uterine fibroids based on a woman's individual case and preferences. Therapeutic options include surgery, hormonal therapy or newer minimally invasive techniques such as Uterine Artery Embolization (pioneered at UCLA) and non invasive techniques such as MR guided Focused Ultrasound therapy. Prior to any therapy, women undergo a pelvic MRI and are individually seen by both a gynecologist and a radiologist.

UCLA Radiology offers two treatments for uterine fibroids:

• UTERINE ARTERY EMBOLIZATION

  Fig. 2: Example of an Uterine Fibroid (A) Pre-treatment, (B) Post-treatment Click for a Larger Picture

  
  Uterine Artery Embolization (UAE), also known as uterine fibroid embolization (UFE), has proven successful in significantly decreasing or eliminating fibroid related symptoms of bleeding, pressure and pain in the majority of the thousands of women with large or multiple uterine fibroids.
  
  In UAE, radiologists carefully place a small catheter into both the right and left uterine arteries and cut off the blood supply to fibroids, causing them to die and shrink. This helps women overcome the debilitating symptoms from fibroids. UAE is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.
  
  Efficacy of UAE Treatment. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. The procedure is effective for multiple fibroids and large fibroids. Recurrence of treated fibroids is very rare. Short and mid-term data show UAE to be very effective with a very low rate of recurrence. Long-term (10-year) data are not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolized regrew.
  
  
• MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND SURGERY
  A New Treatment Choice - Without Knife or Needle
  Approved by FDA in October 2004, MR-guided focused ultrasound surgery (MRgFUS) is a completely non-invasive treatment option for some women with fibroids and shows great promise in the treatment of smaller and medium sized fibroids.
  
  MRgFUS uses high intensity focused ultrasonic waves to destroy (ablate) the fibroids under real-time monitoring of the treated tissue. The use of focused ultrasound surgery (FUS) or high intensity focused ultrasound (HIFU) was first discovered in 1942. MRgFUS allows our interventional radiologist to localize, target, monitor, and control the energy delivered by the ultrasound machine to kill the fibroid, without knife or needle.
  
  Our MRgFUS machine, the Exblate 2000, is FDA approved for the treatment of uterine fibroids. It has proven itself to be a safe, reliable, and effective way to treat fibroids and has prevented numerous women from undergoing surgery.
  
  This 'knifeless surgery' is done as an outpatient procedure and under conscious sedation. Although relatively new, this treatment option will give a subset of women a treatment choice that gives them fast recovery with limited side effects. Currently this procedure is FDA approved for pre-menopausal women with symptomatic uterine fibroids who have no desire for future pregnancy.
  VIDEO: See How Focused Ultrasound Treatment Works from http://www.uterine-fibroids.org.

How to schedule an appointment for a consultation?

If you are interested in scheduling an appointment to see if UAE or MRgFUS is an option for you, please contact Ronetta Jackson at 310-481-7545 or email us at radcons@mednet.ucla.edu for further information.

Where can I get more information about uterine fibroids?

Feel free to email us with questions, concerns, and requests for more information at: UterineFibroidInfo@mednet.ucla.edu.

Informed decision-making is of the utmost importance to us, especially when there are already well-established treatment options for women. The following websites may be useful in educating yourself about uterine fibroids and their management. http://www.nlm.nih.gov/medlineplus/uterinefibroids.html
http://www.womenshealth.gov/faq/fibroids.htm
http://www.healthywomen.org/healthtopics/fibroids http://www.fda.gov/womens/getthefacts/pdfs/fibroids.pdf
http://fibroidrelief.org http://www.uterine-fibroids.org/
http://www.fusfoundation.org/ http://www.acog.org/publications/patient_education/bp074.cfm http://www.sirweb.org/patients/uterine-fibroids/